title: Quality of CPR performed by trained bystanders with optimized pre-arrival instructions.
abstract: OBJECTIVE
  Telephone-CPR (T-CPR) can increase initiation of bystander CPR. We wanted to study if quality oriented continuous T-CPR would improve CPR performance vs. standard T-CPR.
  
  
  METHODS
  Ninety-five trained rescuers aged 22-69 were randomized to standard T-CPR or experimental continuous T-CPR (comprises continuous instructions, questions and encouragement). They were instructed to perform 10 min of chest compressions-only on a manikin, which recorded CPR performance in a small, confined kitchen. Three video-cameras captured algorithm time data, CPR technique and communication. Demography and training experience were captured during debriefing.
  
  
  RESULTS
  Participants receiving continuous T-CPR delivered significantly more chest compressions (median 1000 vs. 870 compressions, p=0.014) and compressed more frequently to a compression rate between 90 and 120 min(-1) (median 87% vs. 60% of compressions, p<0.001), compared to those receiving standard T-CPR. This also resulted in less time without compressions after CPR had started (median 12s vs. 64 s, p<0.001), but longer time interval from initiating contact with dispatcher to first chest compression (median 144 s vs. 84 s, p<0.001). There was no difference in chest compression depth (mean 47 mm vs. 48 mm, p = 0.90) or in demography, education and previous CPR training between the groups.
  
  
  CONCLUSIONS
  In our simulated scenario with CPR trained lay rescuers, experimental continuous T-CPR gave better chest compression rate and less hands-off time during CPR, but resulted in delayed time to first chest compression compared to standard T-CPR instructions.
authors.affiliation: Institute for Experimental Medical Research, Oslo University Hospital and University of Oslo, PO Box 4956 Nydalen, N-0426 Oslo, Norway; Laerdal Medical AS, Tanke Svilandsgate 30, N-4002 Stavanger, Norway. Electronic address: tonje.birkenes@laerdal.no.
authors.forename: Tonje S
authors.initials: TS
authors.lastname: Birkenes
authors.affiliation: Laerdal Medical AS, Tanke Svilandsgate 30, N-4002 Stavanger, Norway.
authors.forename: Helge
authors.initials: H
authors.lastname: Myklebust
authors.affiliation: Institute for Experimental Medical Research, Oslo University Hospital and University of Oslo, PO Box 4956 Nydalen, N-0426 Oslo, Norway.
authors.forename: Andres
authors.initials: A
authors.lastname: Neset
authors.affiliation: Institute for Experimental Medical Research, Oslo University Hospital and University of Oslo, PO Box 4956 Nydalen, N-0426 Oslo, Norway.
authors.forename: Jo
authors.initials: J
authors.lastname: Kramer-Johansen
mesh_terms: D000328:Adult; D016887:Cardiopulmonary Resuscitation / Q000193:education* / Q000592:standards*; D004631:Emergency Medical Service Communication Systems; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D058687:Out-of-Hospital Cardiac Arrest / Q000628:therapy*; D013689:Telephone
keywords: Bystander CPR; CPR; Cardiopulmonary resuscitation; Chest compression; Dispatcher instructions; Pre-arrival instructions